St. Clair checkup

Board certified St. Clair Hospital cardiothoracic surgeon Richard H. Maley Jr., treats conditions of the lungs, esophagus and other structures within the part of the chest between the sternum and spine and between the lungs.

Gastroesophageal reflux, one of the most common conditions he sees, can usually be effectively treated with acid blocking drugs, but it can lead to bigger problems, including Barrett’s Esophagus and esophageal cancer. Barrett’s Esophagus occurs when the cells and tissue at the bottom end of the esophagus are repeatedly exposed to the gastric acid that leaks back into the esophagus in the presence of reflux. Over time, this exposure transforms those cells and they begin to resemble stomach and intestinal tissue. This places a patient at risk of developing dysplasia, the growth of abnormal cells that may be pre-cancerous.

“When dysplasia is present, you have to monitor it,” Dr. Maley says. “There are stages of dysplasia. We can actually treat Barrett’s and dysplasia through the patient’s mouth, using technology that allows us to ‘scope’ the patient—insert an endoscopy tube—and perform an ablation using radiofrequency. We heat the tip of a catheter and burn off targeted tissue to remove it.”

Just 15 years ago, a patient with Barrett’s Esophagus and dysplasia would have to undergo major surgery to remove the esophagus and reconstruct a new one using stomach tissue. With endoscopic ablation, there is no incision, no anesthesia except for light sedation, and no pain.

Esophageal cancer, in the past, was primarily the consequence of smoking and excessive alcohol consumption. It was most often found in the upper esophagus and was a type called squamous cell cancer. Today, with smoking rates falling, that kind of cancer has dramatically decreased, but a different kind of esophageal cancer has emerged—adenocarcinoma—and it affects the lower end of the esophagus. Dr. Maley, who practices with Maley Thoracic Surgery Associates Division of St. Clair Medical Services, says managing reflux and screening for Barrett’s are the best ways to prevent esophageal cancer from developing.

Contact Dr. Maley: 412-942-5710.

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